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Aiming to get right care in right places

THE Great Western Hospital’s new medical director Guy Rooney has ambitious plans to ensure patients receive the best care possible closer to home. He shares his vision for the future with Marion Sauvebois

Q What does the role of medical director involve?A In this role you are part of the senior management team and you are bringing a clinical perspective to the decisions that are made. Since the Francis Report what has come out is the importance of safety, patient experience and making sure that we deliver the best care we can and you need that medical knowledge to do that.

Q Some ophthalmology clinics are now being run from local GP practices; is that the direction you see care provision going in Swindon in the future?A If you think about what is happening nationally, we are having to think about new ways to deliver healthcare. We have got a growing population and people are getting older. To use a comparison, traditionally we have had big supermarkets called hospitals and now we have had to think about having corner shops – that’s working in GP practices to deliver care - and added home delivery, so some of that is having district nurses coming in and caring for people at home.
The aim is for people to get the right care in the right place at the right time and minimise the number of people going to nursing homes.
The ophthalmology clinics were a response to that demand for new ways of working. If you distil and share that expertise with GPs it increases the knowledge on the ground and you are able to listen better.”

Q How are you planning to deal with increasing winter pressures and the growing demand on A&E services?A What happened last winter was because of that population growth. We are dealing with a 15 per cent growth which has affected all parts of the pathway.
The only way we can deal with it is as a team. We are working with SEQOL, social services, GPs and the Clinical Commissioning Group on having a coordinated plan.
It’s not going to be easy because you can’t magic people away.
We also set up ambulatory units a couple of years ago so people come in for 12 hours and receive all the scans and care they need all at once to avoid admissions and maximise care.
The longer someone spends in hospital the more they decompensate and it’s much harder for them to get back home.

Q What progress is being made on the radiotherapy unit front?A Everyone is 100 per cent for the radiotherapy unit. We even want to build a whole cancer centre.
We are now in the cogs and wheels of it and it’s going at its own speed. There will be a campaign soon for people to start raising money and we are very hopeful that people will get behind it.

Q Why is there a shortage of nurses and what can be done about it? Why don’t people want careers in the NHS anymore?A It’s a national shortage, particularly of nursing staff. The bottom line is the number of nursing places at university to deliver the number that we need was not enough.
There has been a workforce mismatch. The whole country is scrambling around looking for nurses. That’s why we are going abroad to get new people.

Q What are the major challenges facing GWH?A The challenges will be attracting the workforce that we need to deliver care, transforming ourselves into an organisation with new ways of working and doing the on-going training.
And managing the change for people because they find change difficult.
We will have to do it in an atmosphere of flat cash.
Just standing still the NHS has to deal with inflation of drugs, wages and equipment and it’s a minimum of four per cent each year.
The shortfall over five to ten years is £20bn.
The real struggle is maintaining quality care and delivering it in that flat cash economy.

Q You have had a few ‘never’ events in recent years. What has been done to prevent this?A The never events we have had have been women who have just had a baby and gone home with vaginal swabs still inside them. No one has come to significant harm from it.
We are human and we all make mistakes. What we are trying to do is put processes in place to overcome human error. Counting swabs was the responsibility of just one person and now we have got two people counting them. We started doing it a couple of years ago and since then we haven’t had any never events.”

Q What are the best and worst performing departments? And what is your priority for the future.A I don’t think it is helpful to look at the best and worst performing departments.
This is a high performing trust and we have been rated six out of six by the Care Quality Commission. We have had excellent records in delivering cancer targets.
Although we are forever fighting the four-hour wait target in A&E, we are doing quite well considering the population growth and the ageing population.
My priority is to make sure people have ownership of the care they deliver.
My role is to drive up standards and maintain those standards. You want people to work well and you want to support them to deliver that care.”